Healthcare Provider Details

I. General information

NPI: 1972713527
Provider Name (Legal Business Name): RONALD H COULSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 SUSSEX AVE E SUITE 3 BOX 676
TENINO WA
98589
US

IV. Provider business mailing address

448 SUSSEX AVE E. TENINO CHIROPRACTIC POBOX 676 PO BOX 676
TENINO WA
98589
US

V. Phone/Fax

Practice location:
  • Phone: 360-264-5999
  • Fax: 360-264-5979
Mailing address:
  • Phone: 360-264-5999
  • Fax: 360-264-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00001296
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: